Early History of the San Francisco General Hospital
When San Francisco’s population burgeoned in the late 1840s, the city had to find a way to cope with its growing number of sick and injured citizens and a widespread tuberculosis epidemic. As the only infirmary was in the city jail, a 150 bed City and County hospital was erected in 1857 on Stockton Street, and was awarded the City contract to provide care to the indigent. Unfortunately, the hospital soon became overcrowded and 15 years later, a new City and County hospital, with 6 32-bed wards, opened on Potrero Street in 1872. Two years later, the prison infirmary was designated as the City Receiving Hospital, and the first centralized Emergency Medical Facility in San Francisco was founded.
While the new hospital looked promising at first, the construction was shoddy, had poor lighting in the operating rooms, and the quality of care was scandalously poor due to lack of funding. In 1879, the City gave the University of California Medical College, along with Cooper Medical College (which later became Stanford) and other local medical schools the responsibility for professional care and staffing. Each college was assigned specific wards and allowed medical students to treat patients.
Although the hospital survived the 1906 earthquake, it was quickly overwhelmed with patients, since many other local hospitals were damaged or destroyed. Bubonic plague and smallpox outbreaks occurred, adding to the overcrowding. In 1915, San Francisco Hospital opened on the same site, adding much-needed capacity. Mission Emergency, an emergency triage center, assumed management of major injuries during the 1930s and 1940s. Its staff would evaluate patients when they first arrived in emergency room. If a life-threatening problem did not exist, but hospitalization appeared necessary, patients with adequate finances were transported to private care facilities. Indigent patients went to San Francisco Hospital. In 1958, the facility was renamed San Francisco General Hospital, and shortly after, Stanford severed its ties at the institution, leaving the University of California as the sole provider of medical staffing. By 1976, the latest and most modern SFGH facility was completed, including a state-of-the-art emergency room.
The Development of the First Trauma System in the United States
The city of San Francisco developed the first complete trauma system in United States, which was centered in its public hospital. This system was designed to provide care 24 hours a day, seven days a week, and 365 days a year for the victims of injury. The program required re-organization of pre-hospital, hospital and post-hospital care. Because of the violence that erupted in the city during the late 1960s, resulting from growing hostility to the Vietnam War, there was a three-fold increase in traumatic injuries. Fortunately, most of the components necessary for the trauma system were already in place. These include the ability to recognize injuries and communicate from the field during an emergency, transport patients by ambulance, and evaluate and resuscitate patients in the emergency room. Additionally a trauma system must possess the capacity to provide immediate operative treatment, provide in-patient hospital care, and have resources for post-hospital rehabilitation.
In 1972, the hospital received a Federal Trauma Center designation as well as a large multi-disciplinary research grant, led by Dr. George Sheldon. Under the leadership of Dr. Sheldon, this innovative research team was dedicated to solving problems related to critical injury. At that time, San Francisco’s trauma program was recognized as the first complete City and County wide trauma system in United States. This model served as an example for other cities throughout the United States and Europe. Because some communities, particularly the privately insured and/or affluent, felt comfortable that their local private hospital was superior to a public trauma center, research was designed to investigate this dilemma. Dr. John West, a graduate of the SFGH trauma program, collaborated with Drs. Donald Trunkey and Robert Lim on a research project which compared the trauma related deaths in Orange County, (the privately insured model) versus San Francisco County, (the public trauma center model). The team reviewed 100 consecutive trauma deaths in Orange County and compared them to an equivalent number of patients treated in San Francisco County. Although the populations of both groups were nearly the same at the time, the study demonstrated that more than one fourth of the deaths from trauma in Orange County were from simple injuries, which, if identified and treated properly, should not have been fatal. By comparison, there was only one such death in San Francisco County. This work has been the first of many studies to date that demonstrate the importance of an organized trauma system.
The History of the UCSF/SFGH Orthopaedic Trauma Center
Dr. Edwin G. “Ted” Bovill, Jr. served as the first chief of orthopaedic surgery at SFGH from 1963 to 1984. He became a full professor in 1969 and vice chairman of the Department of Orthopaedic Surgery in 1971. During his tenure, he specialized in musculoskeletal traumatology and orthopaedic oncology was an active clinical researcher in both traumatology and oncology. He authored over 50 publications and was one of three surgeons who conceived the Orthopaedic Trauma Association (OTA). In 1977, Drs. Bovill, Michael Chapman, and Ramon Gustillo met in a Vietnamese restaurant across the street from the hospital when they first discussed the idea. Their goal was to develop a group dedicated to the care of trauma patients with musculoskeletal injuries. Their meeting led to the creation of the Orthopaedic Trauma Center Study Group, which soon became the Orthopaedic Trauma Hospital Association (OTHA). Between 1977 and 1978, there were nine centers involved with the group, including many of the major pubic trauma centers; Los Angeles County Hospital Los Angeles County Hospital (J. Paul Harvey), San Francisco General Hospital (Edwin Bovill), Harborview Medical Center (Sigvard Hanson, Jr.), Denver General Hospital (Renner Johnson), Cook County Hospital (Arsen Pankovich), Boston City Hospital (David Segal), Parkland Hospital, Maryland Shock-Trauma (Bruce Browner), and Montefiore Hospital Medical Center (Edward Havermann).
The OTHA evolved into the Orthopaedic Trauma Association (OTA), which was officially adopted in 1983 and incorporated in 1985. The first OTA meeting was in 1985, the year that Dr. Chapman served as president of the organization. Their students, including Dr. Timothy Bray and Peter Trafton, became leaders in the field. Today, the OTA is the leading international organization dedicated to orthopaedic traumatology, and the award for the best scientific paper at the annual meeting carries Dr. Bovill’s name. These founders were instrumental in shaping SFGH as a world leader in trauma research, education, and advancements in trauma care.
Drs. Lorraine Day and Guy Paiement followed as chiefs of orthopaedic surgery at SFGH in the 1980s and 1990s. They provided outstanding leadership in developing the clinical service and teaching curriculum. In 2002, Dr. Theodore Miclau took over as Acting Chief of Orthopaedic Surgery at SFGH and departmental vice-chairman, continuing the tradition of excellence in patient care and education. He also began to develop a comprehensive research initiative. Today, as the Chief of Orthopaedic Surgery, he oversees a contingent of highly trained orthopaedic surgeons, trauma specialists, educators, and researchers who are dedicated to the UCSF/SFGH Mission. Their goal is to deliver the best available patient care to all San Franciscans regardless of ability to pay, and to maintain SFGH’s reputation as one of the nation’s best public hospitals.